Surgery for Stage 4 Lung Cancer: 112 Real Stories

Stage IVA lung adenocarcinoma with solitary brain metastasis: pCR after brain surgery, chemoradiation, immunotherapy, and lobectomy

Patient Info: Anonymized, Male, 70+ | Stage IV

Biomarkers: PD-L1 75%; negative for driver gene mutations and translocations

Metastatic Site: brain

As of May 2024, he had no recurrence after brain metastasis resection and radiation, carboplatin/pemetrexed/atezolizumab, robot-assisted right upper lobectomy with pathologic complete response, and 13 cycles of maintenance atezolizumab.

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Metastatic lung adenocarcinoma presenting as a pituitary mass

Patient Info: Anonymized, Female, 60s | Stage IV

Biomarkers: Lung adenocarcinoma with ERBB2 plus other mutations, PD-L1 TPS 1%

Metastatic Site: pituitary gland

As of May 2024, metastatic lung adenocarcinoma to the pituitary/sellar region had been diagnosed pathologically; systemic treatment, recurrence status, and longer follow-up were not described.

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Stage 4 lung adenocarcinoma: brain surgery followed by immunotherapy response

Patient Info: Anonymized, Male, 60s | Stage IV

Biomarkers: PD-L1-positive; EGFR wild-type/no mutation; ALK rearrangement not detected; TTF-1-positive; Napsin A-positive

Metastatic Site: brain

As of March 2024, after 31 cycles of zimberelimab, the lung lesion had shown partial response, brain metastasis had not recurred, and the patient had 24-month progression-free and intracranial recurrence-free survival with normal quality of life.

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Stage IV ALK Lung Adenocarcinoma: Keegan's Survivor Story

Patient Info: Keegan Murphy, Male, 40s | Stage IV

Biomarkers: ALK fusion mutation

Metastatic Site: Lungs; lymph nodes; ribs/bone; abdomen

As of March 2024, Keegan had gone from Stage IV ALK-positive lung adenocarcinoma with tumors in the lungs, lymph nodes, ribs, and abdomen to no evidence of disease after alectinib and surgery.

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Stage IV Non-Small Cell Lung Cancer: Tim's Patient Story

Patient Info: Tim Monds, Male, 50s | Stage IV

Biomarkers: High PD-L1 expression

Metastatic Site: Other lung lobes / lung nodules

As of March 2024, Tim Monds was identified as a Stage IV lung cancer survivor involved in discussion of the PaCES early palliative-care project and broader lung cancer advocacy.

Stage IV EGFR Lung Cancer: Ivy's Survivor Story

Patient Info: Ivy E., Female, 40s | Stage IV

Biomarkers: EGFR mutation

Metastatic Site: Bone: elbow, cervical spine/neck, rib, pelvis; brain

As of January 2024, Ivy reported no evidence of disease 1 year after right upper lobectomy, after years of response to EGFR-targeted therapy for initially Stage IV lung cancer.

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Stage IV Lung Cancer: Deborah's Patient Story

Patient Info: Deborah Persinger, Female, 70+ | Stage IV

Metastatic Site: Brain

As of January 2024, Deborah was living actively 13 years after lung cancer diagnosis, with recurrent brain metastases managed through repeated Gamma Knife radiosurgery and ongoing MRI surveillance.

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Brain radiation therapy complication (radionecrosis) potentially linked to combined chemo-immunotherapy

Patient Info: Anonymized, Female | Stage IV

Biomarkers: PD-L1 0%; tumour mutational burden 33 mutations/Mb; TP53 mutation at diagnosis; later ctDNA included KEAP1 and NOTCH3 alterations

Metastatic Site: brain; presumed leptomeningeal disease

She recovered completely from surgery for radiation necrosis, resumed cancer treatment and remained neurologically intact at 18 months. She was found deceased 9 months later; the cause of death was unknown.

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BRCA2-Mutated Metastatic Lung Adenocarcinoma Controlled for 30 Months With Olaparib

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: PD-L1-negative; BRCA2 mutation; ATM mutation; EGFR-negative; ALK-negative

Metastatic Site: brain

Olaparib provided about 30 months of disease control, and PET imaging remained overall stable when a separate new breast primary was found in February 2023.

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MET-mutated lung cancer: testing savolitinib before surgery

Patient Info: Anonymized, Male, 60s | Stage IV

Biomarkers: MET exon 14 skipping, TP53 and BRAF mutations; PD-L1 expression 5%

Metastatic Site: pleura; mediastinal lymph node

Savolitinib produced a partial radiological response, but surgery confirmed persistent pleural and mediastinal nodal metastases with ypStage IVA disease. He recovered and continued adjuvant savolitinib.

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Lung cancer recurrence in the thyroid, initially mistaken for thyroid cancer

Patient Info: Anonymized, Male | Stage IV

Biomarkers: EGFR exon 19 deletion; TTF-1-positive; Napsin A-positive; PAX8-negative; thyroglobulin staining limited to tumour cells adjacent to normal thyroid tissue

Metastatic Site: thyroid; cervical lymph nodes

After starting osimertinib for EGFR exon 19-deleted recurrent lung adenocarcinoma, he was disease free 5 months after thyroid surgery.

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HER2-positive metastatic lung cancer treated with trastuzumab deruxtecan (Enhertu)

Patient Info: Anonymized, Female | Stage IV

Biomarkers: ERBB2/HER2 copy-number gain of at least 20 copies; TP53 C242fs; CDK12 copy-number gain; tumour mutational burden 3.2 mutations/Mb

Metastatic Site: lungs / multiple pulmonary nodules

Trastuzumab deruxtecan reduced the pulmonary nodules by more than 50% at 3 months and produced a documented response lasting 13.8 months.

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Stage IV Lung Cancer Reached Remission After Severe Nerve Damage and Neck Surgery

Patient Info: Anonymized, Female | Stage IV

Metastatic Site: left cervical lymph nodes

Considered in complete remission after cervical lymph-node surgery, with no clinical or radiological progression 24 months after systemic treatment; alive and back at work 3 years after diagnosis.

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Long-term erlotinib treatment alongside worsening kidney vasculitis

Patient Info: Anonymized, Male, 70+ | Stage IV

Metastatic Site: bone

Bone metastases showed osteosclerotic change after erlotinib began, and the drug continued because he was benefiting from treatment despite worsening renal vasculitis.

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Stage IV Non-Small Cell Lung Cancer: Abby's Survivor Story

Patient Info: Abby Kanarek, Female, 60s | Stage IV

Biomarkers: PD-L1 90%

Metastatic Site: Brain

As of November 2021, Abby was in remission 2 years after only 4 Keytruda infusions, with the lung cancer eliminated and ongoing surveillance by a multidisciplinary City of Hope team.

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Pleomorphic Lung Cancer Progressed Despite Pembrolizumab

Patient Info: Anonymized, Male, 70+ | Stage IV

Biomarkers: EGFR-negative; ALK-negative; ROS1-negative; PD-L1 TPS 80%-90%.

Metastatic Site: small intestine; pleura; abdominal subcutaneous tissue

The cancer did not respond to pembrolizumab, and he died four months after immunotherapy began.

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Pembrolizumab Controlled Metastatic Pleomorphic Lung Cancer After Chemotherapy Failed

Patient Info: Anonymized, Male, 40s | Stage IV

Biomarkers: EGFR-negative; ALK-negative; ROS1-negative; BRAF-negative; PD-L1 TPS 60%-70%; BRCA2, and TP53 mutations; tumor mutation burden 42 mutations/Mb; no actionable alteration.

Metastatic Site: right adrenal gland; left adrenal gland; bone

Tumor diameter had decreased at 11 months, and pembrolizumab remained ongoing at 12 months.

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A painful scalp metastasis from sarcomatoid lung cancer

Patient Info: Anonymized, Female, 50s | Stage IV

Biomarkers: No targetable mutations identified; CAM5.2-positive; p63-positive; CD10-positive; vimentin-positive.

Metastatic Site: chest wall and rib; liver; right gluteal region; scalp…

Her disease progressed with a further liver lesion and additional metastatic complications, and systemic treatment was stopped because of severe immune-related toxicity and the absence of targetable mutations.

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Lung adenocarcinoma first detected through an adrenal metastasis

Patient Info: Anonymized, Male, 60s | Stage IV

Biomarkers: No driver mutations identified.

Metastatic Site: left adrenal gland

After resection of the adrenal metastasis, postoperative imaging showed further thoracic uptake and he began palliative chemotherapy for metastatic lung adenocarcinoma without identified driver mutations.

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Likely lung carcinoma presenting as bilateral adrenal metastases

Patient Info: Anonymized, Male, 70+ | Stage IV

Metastatic Site: bilateral adrenal glands

Three months after bilateral adrenalectomy, he remained under regular oncology surveillance, was receiving steroid replacement, and had not required adjuvant chemotherapy.

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Stage IV Mucinous Lung Cancer Treated With Afatinib and Surgery

Patient Info: Anonymized, Female, 40s | Stage IV

Biomarkers: CD74-NRG1 fusion; ALK/ROS1/EGFR/BRAF/KRAS/MET/HER2 wild type; PD-L1 initially not expressed and later 0%-20%

Metastatic Site: bilateral lungs|bone|right adrenal gland

She was alive and receiving treatment after bone and right-adrenal progression at the latest follow-up.

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Surgery for an isolated splenic metastasis from lung adenocarcinoma

Patient Info: Anonymized, Female, 70+ | Stage IV

Metastatic Site: spleen

Nine months after removal of the isolated splenic metastasis, follow-up showed no local or disseminated recurrence and she remained under regular lung-cancer surveillance.

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A uterine mass revealed a rare metastasis from lung adenocarcinoma

Patient Info: Anonymized, Female, 60s | Stage IV

Biomarkers: CK7-positive; TTF-1-positive; CK20-negative; PAX8-negative; GATA3-negative.

Metastatic Site: uterus within a leiomyoma

Twelve months after removal of the uterine metastasis, she remained well with normal surveillance imaging and no concern for recurrent disease.

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Nivolumab-related adrenal failure during treatment for metastatic lung cancer

Patient Info: Anonymized, Female, 60s | Stage IV

Metastatic Site: brain (left cerebellum)

Her confusion, gastrointestinal symptoms, and hyponatremia improved after glucocorticoid and mineralocorticoid replacement, and she was discharged on ongoing hormone replacement.

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